June 14th, 2007 by Dr. Val Jones in News
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It’s funny how cultures become obsessed with certain physical attributes. In the middle ages warts confirmed the identity of witches, a gap between the front teeth was considered pleasing, and a “heart shaped face” was the epitome of beauty. This past century we’ve vacillated between pleasantly plump to “rail thin” as a standard of loveliness… and in recent years women have become preoccupied with a new menace: cellulite.
Of course, no one had even noticed cellulite until the French coined the term 150 years ago. And unhappily that plague crossed the Atlantic in the 1960s, terrorizing pleasantly plump beauties from that day forward.
An entire industry has sprouted up to combat this dimpled foe – everything from massage to liposuction to caffeinated lotions claim that they will restore a smooth appearance to irregular thighs. Unfortunately, those promises are all empty.
Yes, that’s right – there is no research to suggest that any cellulite treatment has anything but the most modest of effects. The bottom line is that dimply skin is determined by your genes – same as your eye color – and that the majority of women have some degree of cellulite no matter how thin they are. Sure, estrogen can play a role – but basically there’s no escaping estrogen as a woman!
So if you’re one of those people who is a little more dimply than average – here’s what you can do:
1. Wear clothes that cover the dimples. Spanx and biker shorts can be worn underneath trousers and longer skirts to give a smoother appearance.
2. Adjust the lighting in your bedroom and bathroom – diffuse light doesn’t reflect shadows from skin imperfections as much. It’s amazing how lighting can emphasize (or de-emphasize) cellulite.
3. Stay fit and tone your body as much as possible. That way if the rest of your body is lean and firm, the cellulite won’t be that big a deal.
4. Recognize that you will always have cellulite. It’s not your fault, you didn’t cause it and you can’t solve it. Don’t waste your money on creams and treatments that don’t work.
5. Remember that the vast majority of guys don’t even notice cellulite (it’s virtually invisible due to their fixation on other anatomical parts).
6. Blame it on the French. If you fixate on your cellulite you are letting them win! Show those French your best laissez-faire attitude by completely ignoring this “disease” that they concocted.
I vote that we go back to the days before the invention of cellulite and live a carefree, confident existence.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 26th, 2007 by Dr. Val Jones in True Stories
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Even though the gender gap in medicine is closing quickly (about 50% of medical students are female), young female physicians in practice are often viewed with suspicion. Dr. Michelle Au, an anesthesiologist and graduate of my alma mater, is regularly asked if she’s “a real doctor” or if she’s the nurse or a student of some sort. This week she blogged about her experiences, and there was a large volume of interesting responses.
I myself have had a rough time of it in the past (now I guess I look old enough to “be a real doctor”), and was routinely assumed to be a nurse, physical therapist, or even pharmaceutical rep. I actually wasn’t that offended by being miscast – mostly because I took it as a compliment not to look like a doctor. Although it’s somewhat unclear what a real doctor is supposed to look like, I have a feeling he’s older, balding, and paunchy.
But one day I was a little annoyed when my age and gender was equated with incompetence, which crosses the line for me. Here’s how the conversation went between me and the parents of a toddler with a small cut on his forehead:
Me: “Hi, Mr. and Mrs. X, I’m Dr. Jones. I see that Johnny bumped his head and will need a few stitches.” [Enter long history and physical discussion here].
Mrs. X: “Are YOU going to put in the stitches?” She asked nervously, scanning the ED for other physician suturing candidates.
Me: “Yes, I assure you I will be very careful. I’ve sutured many similar lacerations.”
Mr. X: “Yeah, but don’t you think he needs a plastic surgeon?”
Me: Looking at the small cut that only required 2 or 3 sutures. “I understand that you want the best possible cosmetic outcome for your son, but I assure you that this cut is so small that the plastic surgeon wouldn’t close it any differently than I would.”
Mrs. X: Spotting a tall, male intern fiddling with some bandages on a supply cart. “Well, can’t he do it?”
Me: Viewing the clumsy medicine intern. “Well, yes, he could. Shall I ask Dr. Big Hands if he can come and suture your son’s forehead? He’s never closed a lac before and has been dying to try one.”
Mrs. X: Um… Well, maybe you should just do it.
Outcome: I did a beautiful, delicate job of closing the small laceration, and the parents watched in awe as I used the tiniest needle and thread to create a seamless finish.
Mr. X: Thanks for your help. You did a really great job.
Have any of you readers had similar experiences?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 20th, 2007 by Dr. Val Jones in Expert Interviews
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These are the references for the post about HRT and “chemo brain:”
References
1. Gross J. Lingering fog of chemotherapy is no longer
ignored as illusion. New York Times April 29, 2007 p1.
2. Paganini-Hill A, Henderson VW. Estrogen replacement
therapy and risk of Alzheimer’s disease. Arch Intern Med 1996;156:2213-7.
3. Tang MX, Jacobs D, Stern Y, Marder K, Schofield P,
Gurland B, Andrews H, Mayeux R. Effect of oestrogen during menopause on risk
and age at onset of Alzheimer’s disease. Lancet 1996;348:429-32.
4. Manly JJ, Merchant CA, Jacobs DM, Small SA, Bell K, Ferin
M, Mayeux R. Endogenous estrogen levels and Alzheimer’s disease among
postmenopausal women. Neurology 2000;54:833-7.
5. Chung SK, Pfaff DW, Cohen RS. Estrogen-induced
alterations in synaptic morphology in the midbrain central gray. Exp Brain Res
1988;69(3):522-30.
6. Jones KJ. Steroid hormones and neurotrophsim:
relationship to nerve injury. Metab Brain Dis 1988;3:1-16.
7. Nilsen J, Diaz Brinton R. Mechanism of estrogen-medicated
neuroprotection: regulation of mitochondrial calcium and Bcl-2 expression. Proc
Natl Acad Sci USA 2003;100(5):2842-7.
8. Nilsen J, Brinton RD. Mitochondria as therapeutic targets
of estrogen action in the central nervous system. Curr Drug Targets CNS Neurol
Disord 2004;3(4):297-313.
9. Alvarez-de-la-Rosa M, silva I, Nilsen J, Perez MM,
Garcia-Segura LM, Avila J, Naftolin F. Estradiol prevents neural tau
hyperphosphorylation characteristic of Alzheimer’s disease. Ann NY Acad Sci
2005;1052:210-24.
10. Singh M, Meyer EM, Millard WJ, Simpkin JW. Ovarian
steroid deprivation results in a reversal learning impairment and compromised
cholinergic function in female Sprague Dawley rats. Brain Res. 1994;644:305-12.
11. McEwen B, Alves S. Estrogen actions in the central
nervous system. Endocrin Rev 1999;20:279-307.
12. Kampen DL, Sherwin BB. Estrogen use and verbal memory in
healthy postmenopausal women. Obstet Gynecol 1994;83(6):979-83.
13.
Shaywitz SE, Shaywitz BA, Pugh KR, Fulbright RK, Skudlarski P, Mencl WE,
Constable RT, Naftolin F, Palter SF, Marchione KE, Katz L, Shankweiler DP,
Fletcher JM, Lacadie C, Keltz M, Gore JC. Effect of estrogen on brain
activation patterns in postmenopausal women during working memory tasks. JAMA
1999;281(13):1197-202.
14. Duff SJ Hampson E. A beneficial effect of estrogen on
working memory in postmenopausal women taking hormone replacement therapy. Horm
Behav 2000;38(4):262-76.
15.
LeBlanc ES, Janowsky J, Chan BKS, Nelson HD. Hormone replacement therapy and
cognition. Systemic review and meta-analysis. JAMA 2001;285(11):1489-99.
16.
Zandi PP, Carlson MC, Plassman BL, Welsh-Bohmer KA, Mayer LS, Steffens DC,
Breitner JC. Hormone replacement therapy and incidence of Alzheimer’s disease
in older women. The Cache County
Study. JAMA 2002
288(17):2123-9.
17.
MacLennan AH, Henderson VW, Paine BJ, Mathias J,
Ramsay EN, Ryan P, Stocks NP, Taylor
AW. Hormone therapy, timing of initiation, and cognition in women aged older
than 60 years: the REMEMBER pilot study. (Research into Memory, Brain function
and Estrogen Replacement). Menopuase: The Journal of the North American
Menopause Society 2006;13(1):28-36.
18.
Shumaker SA, Legault C, Rapp SR, and the WHIMS investigators. Estrogen plus
progestin and the incidence of dementia and mild cognitive impairment in
postmenopausal women: The Women’s Health Initiative Memory Study: A randomized
controlled trial. JAMA 2003;289(20):2651-62.
19.
Shumaker SA, Legault C, Kuller L, et al. Conjugated equine estrogens and
incidence of probably dementia and mild cognitive impairment in postmenopausal
women: Women’s Health Initiative memory Study. JAMA 2004;291(24):2947-58.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 20th, 2007 by Dr. Val Jones in Expert Interviews
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Every now and then I have the pleasure of featuring a guest blogger – someone whose medical opinions are particularly intriguing or controversial. Dr. Avrum Bluming submitted a really interesting post last month about cancer – and whether or not we scientists really do understand it fully. In this post, Dr. Bluming reviews the scientific literature on Hormone Replacement Therapy, and finds some interesting evidence that estrogen might actually be good for the brain – to reduce the risk of dementia. He also suggests that “chemo brain” – the mental fog associated with cancer therapy (especially breast cancer), may be caused by a rapid decrease in estrogen. Read his comments carefully and let me know if you find his analysis convincing… And watch out for the passionate “zinger” at the end!
————
The April 29th 2007 issue of the Sunday New York
Times carried a front-page article about the mental fog following treatment of
cancer with chemotherapy.(1) This fog, referred to as chemo brain, usually
clears, but, in approximately 15% of treated patients, may persist for years,
according to the article. All the patients presented
in the article were women, most or all were breast cancer survivors, and the
article does state that a possible cause of chemo brain in these women may be
the lowered estrogen in their bodies, due to their being catapulted into
premature menopause by treatment. The article further states that abrupt
menopause leaves many women fuzzy headed in a more extreme way than natural
menopause, which usually develops gradually. The article goes on to say that
studies of chemo brain have been conducted, overwhelmingly among breast cancer
patients because they represent the largest group of cancer survivors and
because they tend to be sophisticated advocates, challenging doctors and
volunteering for research.
In 1996 a
14-year study concluded that estrogen replacement therapy may be useful for
preventing or delaying the onset of Alzheimer’s disease.(2)
In 1997 a Columbia University study reported a significant
reduction in the risk of Alzheimer’s disease among postmenopausal women taking
estrogen.(3)
In 2000 that same group reported lower levels
of circulating estradiol, the most common form of circulating estrogen, among
women who developed Alzheimer’s disease compared to those who did not.(4)
Estrogen
has been reported to stimulate nerve growth and synapse formation.(5) (Synapses
are nerve to nerve connections), and to play a beneficial role in nerve response to injury.(6)
In 2003 researchers at the University
of Southern California
identified a mechanism for estrogen-mediated nerve cell protection, which
involved preventing the accumulation of calcium within the mitochondria of the
nerve cells.(7,8)
Estrogen
has also been shown to prevent the buildup of the abnormal chemical called
hyperphosphorylated tau protein, characteristic of Alzheimer’s disease.(9)
Estrogen
administered to female rats who have had their ovaries removed enhanced the
rats’ learning ability.(10,11)
Estrogen
administration to postmenopausal women has been associated with improved verbal
memory.(12-14)
A 2001 analysis of 29 published studies concluded that hormone replacement therapy was
associated with a 34% decreased risk of dementia.(15)
A 2002 study from Johns Hopkins reported a 67% decreased incidence of Alzheimer’s
disease associated with hormone replacement therapy.(16)
A 2006 study from Stanford and the University
of Adelaide in Australia
concluded that early initiation of hormone replacement therapy, from around the
time of menopause may contribute to improved cognition with aging and may delay
dementia.(17)
One can
often selectively quote the medical literature to support a particular point of
view. However, in the face of all these previously quoted studies, one should
at least look skeptically upon the 2003 report from the Women’s Health
Initiative, which found that combination estrogen plus progestin hormone
replacement therapy increased the risk for dementia when started in women over
age 65. The study reported increased dementia as early as 12 months after
starting HRT, but no increased incidence of mild cognitive impairment
associated with HRT use.(18) If HRT
were really harmful to the brain, a finding that goes against most of what we
think we understand about the beneficial effects of estrogen on brain function,
one would expect early cognitive impairment to become apparent before
full-blown dementia was encountered.
A June, 2004 update of that same study concluded that even estrogen alone increased the
risk for dementia. This update reported an increase in mild cognitive
impairment as well, but the results for mild cognitive impairment were not
statistically significant after women who had this impairment at the start of
the study were excluded from analysis.(19)
The report
on chemo-brain from the New York Times should force us to look again at the
role of estrogen in maintaining normal brain function. Throughout history, male
dominated societies have adopted practices harmful to women. These include foot
binding, genital mutilation, and withholding privileges such as the right to
vote, hold office, and participate in government and education activities. We
should not add premature elimination of HRT, based on facile conclusions and
conflicting data to this list.
Avrum Bluming,
MD, MACP
Clinical Professor of Medicine
University
of Southern California
(References on next post)
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 18th, 2007 by Dr. Val Jones in True Stories
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Always do right. This will gratify some people and astonish the rest.
–Mark Twain
My favorite writer of all time is Mark Twain. His keen observations and uncanny ability to combine wisdom and wit makes his writing incredibly entertaining, don’t you think? I thought it would be fun to take a few of his quotes and illustrate them with true stories from my mental archives.
Today’s quote is about doing the right thing. I remember a case where a young internal medicine intern was taking care of a 42 year old mother of 3. The mother had HIV/AIDS and had come to the hospital to have her PEG tube repositioned. Somewhere along the way, she required a central line placement, and as a result ended up with a pretty severe line infection. The woman’s condition was rapidly deteriorating on the medicine inpatient service, and the intern taking care of her called the ICU fellow to evaluate her for admission to the intensive care unit.
The fellow examined the patient and explained to the intern that the woman had “end stage AIDS” and that excessive intensive care management would be a futile endeavor, and that the ICU beds must be reserved for other patients.
“But she was fine when she came to us, the line we put in caused her downward spiral – she’s not necessarily ‘end stage,’” protested the intern.
The fellow wouldn’t budge, and so the intern was left to manage the patient – now with a resting heart rate of 170 and dropping blood pressure. The intern stayed up all night, aggressively hydrating the woman and administering IV antibiotics with the nursing staff.
The next day the intern called the ICU fellow again, explaining that the patient was getting worse. The ICU fellow responded that he’d already seen the patient and that his decision still stands. The intern called her senior resident, who told her that there was nothing he could do if the ICU fellow didn’t want to admit the patient.
The intern went back to the patient’s room and held her cold, cachectic hand. “How are you feeling?” she asked nervously.
The frail woman turned her head to the intern and whispered simply, “I am so scared.”
The intern decided to call the hospital’s ethics committee to explain the case and ask if it really was appropriate to prevent a young mother from being admitted to the ICU if she had been in reasonable health until her recent admission. The president of the ethics committee reviewed the case immediately, and called the ICU fellow’s attending and required him to admit the patient. Soon thereafter, the patient was wheeled into the ICU, where she was treated aggressively for sepsis and heart failure.
The next day during ICU rounds the attending physician asked for the name of the intern who had insisted on the admission. After hearing the name, he simply replied with a wry smile, “remind me never to f [mess] with her.”
The patient survived the infection and spent mother’s day with her children several weeks later.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
